The Cornell-Hospital for Special Surgery Multipurpose Arthritis and Musculoskeletal Disease Center (MAMDC) has grown into a mature and highly sophisticated multidisciplinary research effort dedicated to improving our understanding and treatment of musculoskeletal diseases. The long-term objectives of the MAMDC include: 1) to support excellence in laboratory, clinical, behavioral and health services research related to musculoskeletal diseases; 2) to provide training in state-of-the-art methodology in research which can be applied to important questions in both orthopedics and rheumatology; 3) to develop a critical mass of experienced orthopedic, rheumatology, anesthesiology, and arthritis health investigators who can serve as role models and mentors for young new investigators; 4) to develop new educational programs and technologies designed to meet emerging needs in professional, patient and community education; 5) to serve as a research resource in the Cornell University Medical Center (CUMC) and to draw attention and effort to critical problems in musculoskeletal disease. The long-term objectives of the MAMDC will be realized through a series of specific, coordinated efforts. It will provide an important stimulus for young orthopedic (Haas, Deland), rheumatic disease (Ashany, Porges, Ivashkiv), and anesthesiology (Richman) investigators. It will support scientific innovation and the development of new and promising directions of inquiry through focused feasibility studies investigating problems related to: transgenic models of osteocalcin deficiency, the analysis of B cell progenitors in autoimmune mice, the effect of mechanical load on solute transport in tendon fibroblasts, monocyte gene activation in inflammatory arthritis, the definition of the role of Fcgamma receptors in antineutrophil cytoplasmic antibody-mediated cellular activation. Employing state-of-the-art concepts in health services, clinical epidemiology, health education and behavioral sciences, the MAMDC will assess, in randomized trials, the effectiveness and cost of arthroscopic debridement vs. tidal lavage for the treatment of mild-moderate osteoarthritis, the efficacy of epidural steroids vs. epidural analgesia for relief of pain and disability due to spinal stenosis, the effectiveness of orthotics for the treatment of heel pain, and trial of self-efficacy in rehabilitation of hip fracture patients. Serving as a pivotal research and educational resource to MAMDC investigators and to the CUMC community, the MAMDC will provide five critical Core facilities in Flow Cytometry and Cell Sorting, Cell culture, Molecular Biology, Analytical Microscopy, and Research Methodology. Such Core facilities can provide an integration and cohesion which touches all aspects of the medical center. Thus, the MAMDC at Cornell reflects an ongoing, strong commitment to advance scientific and educational innovation as it relates to patients with rheumatic diseases and orthopedic disorders.